Chronic Disease Surveillance
0.1.0 - CI Build International flag

Chronic Disease Surveillance, published by Clinical Quality Framework. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/aphl-chronic-ig/ and changes regularly. See the Directory of published versions

Library: ControllingHighBloodPressureFHIR (Experimental)

Official URL: http://fhir.org/guides/cqf/aphl/chronic-ds/Library/ControllingHighBloodPressureFHIR Version: 0.1.0
Active as of 2025-09-25 Computable Name: ControllingHighBloodPressureFHIR
Metadata
Version 0.1.0
Experimental true
Jurisdiction 001 from http://unstats.un.org/unsd/methods/m49/m49.htm
Steward (Publisher) Clinical Quality Framework
Type logic-library from http://terminology.hl7.org/CodeSystem/library-type
Parameter Name: Measurement Period
Use: In
Min Cardinality: 0
Max Cardinality: 1
Type: Period
Parameter Name: Patient
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: Patient
Parameter Name: SDE Ethnicity
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Coding
Parameter Name: SDE Payer
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Resource
Parameter Name: SDE Race
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Coding
Parameter Name: SDE Sex
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: Coding
Parameter Name: SDE Age
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: integer
Parameter Name: Stratifier Age Group
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: Coding
Parameter Name: SDE State of Residence
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: string
Parameter Name: SDE Postal Code of Residence
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: string
Parameter Name: SDE Food Insecurity Risk Status
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: CodeableConcept
Parameter Name: Qualifying Diastolic Blood Pressure Reading
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Observation
Parameter Name: Qualifying Systolic Blood Pressure Reading
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Observation
Parameter Name: Blood Pressure Days
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: dateTime
Parameter Name: Most Recent Blood Pressure Day
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: dateTime
Parameter Name: Lowest Diastolic Reading on Most Recent Blood Pressure Day
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: Quantity
Parameter Name: Has Diastolic Blood Pressure Less Than 90
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: boolean
Parameter Name: Lowest Systolic Reading on Most Recent Blood Pressure Day
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: Quantity
Parameter Name: Has Systolic Blood Pressure Less Than 140
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: boolean
Parameter Name: Numerator
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: boolean
Parameter Name: Essential Hypertension Diagnosis
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Condition
Parameter Name: Initial Population
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: boolean
Parameter Name: Pregnancy Or Renal Diagnosis
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Condition
Parameter Name: Denominator
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: boolean
Parameter Name: End Stage Renal Disease Encounter
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Encounter
Parameter Name: End Stage Renal Disease Procedures
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Procedure
Parameter Name: Denominator Exclusion
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: boolean
Data Requirement Type: Patient
Profile(s): Patient
Data Requirement Type: Observation
Profile(s): Observation
Must Support Elements: code, effective, status, component
Code Filter(s):
Path: code
Code(s): LOINC 85354-9: blood pressure
Data Requirement Type: Encounter
Profile(s): Encounter
Must Support Elements: type, period
Code Filter(s):
Path: type
ValueSet: Encounter Inpatient
Data Requirement Type: Encounter
Profile(s): Encounter
Must Support Elements: type, period
Code Filter(s):
Path: type
ValueSet: Emergency Department Visit
Data Requirement Type: Encounter
Profile(s): Encounter
Must Support Elements: type, status, period
Code Filter(s):
Path: type
ValueSet: ESRD Monthly Outpatient Services
Data Requirement Type: Condition
Profile(s): Condition
Must Support Elements: code, verificationStatus, recordedDate
Code Filter(s):
Path: code
ValueSet: Essential Hypertension
Data Requirement Type: Condition
Profile(s): Condition
Must Support Elements: code, verificationStatus, recordedDate
Code Filter(s):
Path: code
ValueSet: Pregnancy
Data Requirement Type: Condition
Profile(s): Condition
Must Support Elements: code, verificationStatus, recordedDate
Code Filter(s):
Path: code
ValueSet: End Stage Renal Disease
Data Requirement Type: Condition
Profile(s): Condition
Must Support Elements: code, verificationStatus, recordedDate
Code Filter(s):
Path: code
ValueSet: Kidney Transplant Recipient
Data Requirement Type: Condition
Profile(s): Condition
Must Support Elements: code, verificationStatus, recordedDate
Code Filter(s):
Path: code
ValueSet: Chronic Kidney Disease, Stage 5
Data Requirement Type: Procedure
Profile(s): Procedure
Must Support Elements: code, status, performed
Code Filter(s):
Path: code
ValueSet: Kidney Transplant
Data Requirement Type: Procedure
Profile(s): Procedure
Must Support Elements: code, status, performed
Code Filter(s):
Path: code
ValueSet: Dialysis Services
Library Content
CQL Content 
/*
FHIR Translation of CMS165v9: Controlling High Blood Pressure (CBP)
*/
library ControllingHighBloodPressureFHIR version '9.0.000'

using FHIR version '4.0.1'

include FHIRHelpers version '4.1.000' called FHIRHelpers
include FHIRCommon called FC
include MATGlobalCommonFunctionsFHIR4 version '6.0.000' called Common
include AdultOutpatientEncountersFHIR4 version '2.0.000' called AdultOutpatientEncounters
include SupplementalDataElementsFHIR4 version '2.0.000' called SDE
include AdvancedIllnessandFrailtyExclusionECQMFHIR4 version '5.12.000' called FrailtyLTI
include HospiceFHIR4 version '2.0.000' called Hospice
include SurveillanceDataElementsFHIR4 version '1.0.000' called SurveillanceDataElements
include PalliativeCareFHIR called PalliativeCare

codesystem "LOINC": 'http://loinc.org'

valueset "Chronic Kidney Disease, Stage 5": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1002'
valueset "Dialysis Services": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.109.12.1013'
valueset "ED": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1085'
valueset "Encounter Inpatient": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307'
valueset "End Stage Renal Disease": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.353'
valueset "ESRD Monthly Outpatient Services": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.109.12.1014'
valueset "Essential Hypertension": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.104.12.1011'
valueset "Ethnicity": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.837'
valueset "Kidney Transplant": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.109.12.1012'
valueset "Kidney Transplant Recipient": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.109.12.1029'
valueset "ONC Administrative Sex": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1'
valueset "Payer": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591'
valueset "Pregnancy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.378'
valueset "Race": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.836'
valueset "Vascular Access for Dialysis": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.109.12.1011'
valueset "Emergency Department Evaluation and Management Visit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1010'

code "Birth date": '21112-8' from "LOINC" display 'Birth date'
code "Blood pressure": '85354-9' from "LOINC" display 'blood pressure'
code "Diastolic blood pressure": '8462-4' from "LOINC" display 'Diastolic blood pressure'
code "Systolic blood pressure": '8480-6' from "LOINC" display 'Systolic blood pressure'

parameter "Measurement Period" Interval<DateTime> default Interval[@2025-01-01T00:00:00.0-06:00, @2025-12-31T23:59:59.999-06:00]

context Patient

define "SDE Ethnicity":
  SDE."SDE Ethnicity"

define "SDE Payer":
  SDE."SDE Payer"

define "SDE Race":
  SDE."SDE Race"

define "SDE Sex":
  SDE."SDE Sex"

define "SDE Age":
  SurveillanceDataElements."Age"

define "Stratifier Age Group":
  SurveillanceDataElements."Age Group"

define "SDE State of Residence":
  SurveillanceDataElements."State of Residence"

define "SDE Postal Code of Residence":
  SurveillanceDataElements."Postal Code of Residence"

define "SDE Food Insecurity Risk Status":
  SurveillanceDataElements."Food Insecurity Risk Status"

define "Has Diastolic Blood Pressure Less Than 90":
    "Lowest Diastolic Reading on Most Recent Blood Pressure Day" < 90 'mm[Hg]'

define "Has Systolic Blood Pressure Less Than 140":
	"Lowest Systolic Reading on Most Recent Blood Pressure Day" < 140 'mm[Hg]'

define "Lowest Diastolic Reading on Most Recent Blood Pressure Day":
	First(
        "Qualifying Diastolic Blood Pressure Reading" DBPReading
		    where Common.Earliest(DBPReading.effective) same day as "Most Recent Blood Pressure Day"
        return singleton from (
            DBPReading.component C
                where C.code ~ "Diastolic blood pressure"
                return C.value as FHIR.Quantity
        ) sort ascending
	)

define "Lowest Systolic Reading on Most Recent Blood Pressure Day":
	First(
        "Qualifying Systolic Blood Pressure Reading" SBPReading
		    where Common.Latest(SBPReading.effective) same day as "Most Recent Blood Pressure Day"
        return singleton from (
            SBPReading.component C
                where C.code ~ "Systolic blood pressure"
                return C.value as FHIR.Quantity
        ) sort ascending
    )

define "Blood Pressure Days":
	("Qualifying Diastolic Blood Pressure Reading" DBPExam 
        return Common.Latest(DBPExam.effective)
    ) 
        intersect ("Qualifying Systolic Blood Pressure Reading" SBPExam 
            return Common.Latest(SBPExam.effective)
        )

define "Most Recent Blood Pressure Day":
	Max("Blood Pressure Days")

define "Qualifying Diastolic Blood Pressure Reading":
	[Observation: "Blood pressure"] BloodPressure
    without ([Encounter: "Encounter Inpatient"]
      union [Encounter: "Emergency Department Evaluation and Management Visit"]) DisqualifyingEncounter
      such that Common.Latest(BloodPressure.effective) during day of DisqualifyingEncounter.period
    where BloodPressure.status in {'final', 'amended'}
      and Common.Latest(BloodPressure.effective) during "Measurement Period"
      and exists (
        BloodPressure.component DiastolicBP
          where DiastolicBP.code ~ "Diastolic blood pressure"
            and (DiastolicBP.value as Quantity).code.value = 'mm[Hg]'
      )

define "Qualifying Systolic Blood Pressure Reading":
	[Observation: "Blood pressure"] BloodPressure
    without ([Encounter: "Encounter Inpatient"]
      union [Encounter: "Emergency Department Evaluation and Management Visit"]) DisqualifyingEncounter
      such that Common.Latest(BloodPressure.effective) during day of DisqualifyingEncounter.period
    where BloodPressure.status in {'final', 'amended'}
      and Common.Latest(BloodPressure.effective) during "Measurement Period"
      and exists (
        BloodPressure.component SystolicBP
          where SystolicBP.code ~ "Systolic blood pressure"
            and (SystolicBP.value as Quantity).code.value = 'mm[Hg]'
      )

define "Numerator":
	"Has Diastolic Blood Pressure Less Than 90"
	    and "Has Systolic Blood Pressure Less Than 140"

define "Initial Population":
  AgeInYearsAt(date from end of "Measurement Period") in Interval[18, 85]
		and exists "Essential Hypertension Diagnosis"
		and exists AdultOutpatientEncounters."Qualifying Encounters"

define "Pregnancy Or Renal Diagnosis":
	( [Condition: "Pregnancy"]
		union [Condition: "End Stage Renal Disease"]
		union [Condition: "Kidney Transplant Recipient"]
		union [Condition: "Chronic Kidney Disease, Stage 5"] ) PregnancyESRDDiagnosis
      where PregnancyESRDDiagnosis.verificationStatus ~ Common."confirmed"
        and PregnancyESRDDiagnosis.recordedDate during "Measurement Period"

define "Denominator":
	"Initial Population"

define "End Stage Renal Disease Encounter":
	[Encounter: "ESRD Monthly Outpatient Services"] ESRDEncounter
		where ESRDEncounter.status in { 'arrived', 'triaged', 'in-progress', 'onleave', 'finished' }
		  and ESRDEncounter.period starts on or before end of "Measurement Period"

define "End Stage Renal Disease Procedures":
	([Procedure: "Kidney Transplant"]
		union [Procedure: "Dialysis Services"]) ESRDProcedure
		    where ESRDProcedure.status = 'completed'
                and end of Common."Normalize Interval"(ESRDProcedure.performed) on or before end of "Measurement Period"

define "Essential Hypertension Diagnosis":
	[Condition: "Essential Hypertension"] Hypertension
    where Hypertension.verificationStatus ~ Common."confirmed"
      and Common."Prevalence Period"(Hypertension) overlaps Interval[start of "Measurement Period", start of "Measurement Period" + 6 months]

define "Denominator Exclusion":
  Hospice."Has Hospice"
    or exists ("Pregnancy Or Renal Diagnosis")
    or exists ("End Stage Renal Disease Procedures")
    or exists ("End Stage Renal Disease Encounter")
    or FrailtyLTI."Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty"
    or FrailtyLTI."Is Age 66 or Older Living Long Term in a Nursing Home"
    or PalliativeCare."Palliative Care in the Measurement Period"
ELM XML Content 
Encoded data (170872 characters)
ELM JSON Content 
Encoded data (314060 characters)
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